AccountId: 011433970860
ContactId: 2aaca54c-d59a-4326-899e-92f6ea46094b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 754020 ms
Total Talk Time (AGENT): 187161 ms
Total Talk Time (CUSTOMER): 210019 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/2aaca54c-d59a-4326-899e-92f6ea46094b_20250219T19:15_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I have a patient in the chair and he just gave me his insurance information. May I get a quick breakdown of benefits from you, please?
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, [PII] and now I need a book. Mhm.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, yeah, what did I just do with that? It is 255-8140.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And for a complete breakdown, I can fax that to you.
[CUSTOMER][NEUTRAL] He's already in the chair and I don't wanna take the risk of not getting it because he's also getting treatment, so I need to be able to tell him.
[CUSTOMER][NEUTRAL] Um, can I get a group number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, yes, ma'am. The group number is.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 14774.
[CUSTOMER][NEUTRAL] OK, and what is the group name?
[AGENT][NEUTRAL] The group name is Universal Trucking.
[AGENT][NEUTRAL] Keenan advantage.
[CUSTOMER][NEUTRAL] Tracking.
[AGENT][NEUTRAL] Um, Keenan is spelled K like kite, E like Edward, N like Nancy, A like apple, N like Nancy.
[AGENT][NEUTRAL] Advantage.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, and is this a calendar or plan year?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][NEUTRAL] OK, and may I get the address?
[AGENT][NEUTRAL] Um, yes, it's, it's American Public Life.
[CUSTOMER][NEUTRAL] For claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] I'm so sorry, [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then what is the payer ID for electronic claims?
[AGENT][NEUTRAL] Um, the pay ID is [PII].
[CUSTOMER][NEUTRAL] OK, is there any waiting periods?
[AGENT][NEUTRAL] Um, let's see. For major expenses, yes, there's a 12-month waiting period.
[AGENT][NEUTRAL] For
[CUSTOMER][NEUTRAL] And what falls under major?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, there's a long list. Do you have a particular code or?
[CUSTOMER][NEUTRAL] Um, can you tell me if, uh, 4341 falls under that?
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] No, ma'am, it doesn't.
[CUSTOMER][NEUTRAL] Is it under basic?
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Yes, ma'am. I'm still here. I'm waiting on my system.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] Hey, good afternoon. How are you doing today?
[CUSTOMER][NEUTRAL] Um, hey, I was.
[AGENT][NEUTRAL] OK, it's on the periodontic and let's see.
[AGENT][NEUTRAL] There's a maximum of 1 each quadrant every 24 months, and let's see if there's a waiting period.
[AGENT][NEUTRAL] Yeah, it's, it's covered at 40% and there's a 12-month waiting period.
[CUSTOMER][NEUTRAL] 4 months.
[AGENT][NEUTRAL] Um, 12 month waiting period.
[CUSTOMER][NEUTRAL] OK, so it's fallen under major. OK, what about a 3330?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So it's the same one.
[CUSTOMER][NEUTRAL] OK well yeah.
[CUSTOMER][POSITIVE] Uh yes, ma'am, we do accept.
[CUSTOMER][NEUTRAL] Let me take a look.
[CUSTOMER][NEUTRAL] Um, so it does look like it's been since 20.
[AGENT][NEGATIVE] It's also falling under major twelve-month waiting period.
[CUSTOMER][NEUTRAL] OK, and what about a 7 to 10?
[CUSTOMER][NEUTRAL] Um, give me one second to take a look.
[AGENT][NEUTRAL] Yes, ma'am. It's also a 12-month waiting period.
[CUSTOMER][NEUTRAL] And what about a 9944?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] Oh my [PII], did you wanna watch it today.
[CUSTOMER][NEUTRAL] See what my uh what day I work back to the.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't see a 9944. I see a 9940.
[CUSTOMER][NEUTRAL] Is that a night guard?
[CUSTOMER][NEUTRAL] Do you have availability do you like mornings or afternoons?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Is it um basic or major or is there any coverage on it?
[CUSTOMER][NEUTRAL] Um, I don't have a 9. I do have a 10:30.
[AGENT][NEUTRAL] Yes, it's, it's under major, covered under major.
[CUSTOMER][NEUTRAL] OK, and then what is um the 2392, what is the frequency on that?
[CUSTOMER][NEUTRAL] [PII] at 10:30.
[CUSTOMER][NEUTRAL] Thursday
[CUSTOMER][POSITIVE] Awesome well then I have you down and we will see you then.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][NEUTRAL] OK. There's a maximum of 1 tooth every 24 months and replacement of existing only is in place for 24 months. And I'm showing that there's no waiting period.
[CUSTOMER][NEUTRAL] And what percentage is that covered at huh?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] At 80%.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then is do y'all pay on pre seat date for crowns?
[AGENT][NEUTRAL] Under this policy
[CUSTOMER][NEUTRAL] So that'd be
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] On seat date.
[CUSTOMER][NEUTRAL] OK, and then what is the replacement rule on it?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Maximum of 1 per seven-year period.
[CUSTOMER][NEUTRAL] OK, is there a missing tooth cloth?
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] Yes, there is a missing tooth cloth.
[CUSTOMER][NEUTRAL] And then is there implant coverage?
[CUSTOMER][NEUTRAL] After the 12 months?
[AGENT][NEUTRAL] No, ma'am. There's no coverage for implants.
[CUSTOMER][NEUTRAL] OK, and then what is the frequency for 0120?
[CUSTOMER][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] OK, I'm showing that it's covered at 100% and zero waiting period.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] One every 6 months.
[CUSTOMER][NEUTRAL] OK, and what about a cleaning?
[AGENT][NEUTRAL] OK, 1 every 6 months.
[CUSTOMER][NEUTRAL] Invite wings?
[AGENT][NEUTRAL] One per 12-month period.
[CUSTOMER][NEUTRAL] And a full mouth x-ray.
[AGENT][NEUTRAL] 1 every 5 years.
[CUSTOMER][NEUTRAL] OK, and then may I get his maximum?
[AGENT][NEUTRAL] Um, yes, the maximum is $1500 per calendar year and there's a $50 deductible.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Alright, and then I just want to double check the PO box is [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] And the payer ID is 60801.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for your help today I greatly appreciate you.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No ma'am I appreciate your help.
[AGENT][POSITIVE] OK. I thank you again, [PII] for calling APO. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you and bye bye.
[AGENT][POSITIVE] Thank you.